A negative byproduct of positively reinforcing group role and norm adherence is that groups tend to:

Understanding Culture in the Context of Healthcare

Cultural orientation is just one of many different perspectives that individuals draw on as they make health and healthcare decisions. Individual psychology, past experiences, religious and spiritual views, social position, socioeconomic status, and family norms all can contribute to a person's health beliefs and practices. These beliefs and practices can also change over time and may be expressed differently in different situations and circumstances. Because of the significant variability in health beliefs and behaviors seen among members of the same cultural group, an approach to cultural competency that emphasizes a knowledge set of specific cultural health practices in different cultural groups could lead to false assumptions and stereotyping. Knowledge is important, but it only goes so far. Instead, an approach that focuses on the healthcare provider acquiring skills and attitudes relating to open and effective communication styles is a preferable approach to culturally effective and informed care. Such an approach does not rely on rote knowledge of facts that may change depending on time, place, and individuals. Instead, it provides a skills toolbox that can be used in all circumstances. The following skills can lead to a culturally informed approach to care:

Don't assume. Presupposing that a particular patient may have certain beliefs, or may act in a particular way based on their cultural group affiliation, could lead to incorrect assumptions. Sources of intracultural diversity are varied.

Practice humility. Cultural humility has been described byHook et al. (2013) as “the ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity.” Cultural humility goes beyond cultural competency in that it requires the clinician to self-reflect and acknowledge that one'sown cultural orientation enters into any transaction with a patient (seeChapter 2.1).

Cultural humility aims to fix power imbalances between the dominant (hospital-medical) culture and the patient. It recognizes the value of the patient's culture and incorporates the patient's life experiences and understanding outside the scope of the provider; it creates a collaboration and a partnership.

Cultural competency is an approach that typically focuses on the patient's culture, whereas cultural humility acknowledges that both physicians and patients have cultural orientations, and that a successful relationship requires give and take among those differing perspectives. It also includes an understanding that differences in social power, which are inherent in the physician–patient relationship, need to be understood and addressed so that open communication can occur.

Understand privilege. Members of the majority culture have certain privileges and benefits that are often unrecognized and unacknowledged. For example, they can have high expectations that they will be positively represented in media such as movies and television. Compared with minority groups, those in the majority culture have less chance of being followed by security guards at stores, or having their bags checked. They have a greater chance of having a positive reception in a new neighborhood, or of finding food in the supermarket that is consistent with one's heritage. These privileges typically go unnoticed by members of the majority culture, but their absence is painfully recognized by members of nonmajority cultural groups. The culturally informed physician should try to be mindful of these privileges, and how they may influence the interaction between physicians and patients.

Be inquisitive. Because of the significant amount of intracultural diversity of beliefs and practices, the only way to know a particular patient's approach to issues concerning health and illness is through direct and effective communication. Asking about the patient's/family's perspective in an inquisitive and respectful manner will usually be met with open and honest responses, as long as the patient does not feel looked down on and the questions are asked in genuine interest. Obtaining ahealth beliefs history is an effective way of understanding clinical issues from the patient's and family's perspective (Table 11.2). The health beliefs history gathers information on the patient's views on the identification of health problems, causes, susceptibility, signs and symptoms, concerns, treatment, and expectations. Responses gathered from the health beliefs history can be helpful in guiding care plans and health education interventions.

Be flexible. As members of the culture of medicine, clinicians have been educated and acculturated to the biomedical model as the optimal approach to health and illness. Patients and families may have health beliefs and practices that do not fully fit the biomedical model. Traditional beliefs and practices may be used in tandem with biomedical approaches. An individual's approach to health rarely is exclusively biomedical or traditional, and often a combination of multiple approaches. The health beliefs history provides clinicians with information regarding the nonbiomedical beliefs and practices that may be held by the patient. Culturally informed physicians should be flexible and find ways of integrating nonharmful traditional beliefs and practices into the medical care plan to make that plan fit the patient's needs and worldview. This will likely result in better adherence to treatment and prevention.

Acculturation

Acculturation refers to the acquisition and adaptation to the cultural values, attitudes, and practices of the majority culture (Berry, 2005). Typically, as individuals acculturate they acquire behaviors, beliefs, and attitudes that are similar to those of the majority cultural group. Most of the acculturation research has focused on understanding if acculturation contributes to the development of negative health outcomes or serves as a protective factor (Potochnick & Perreira, 2010). Some authors suggest that acculturation could either increase or reduce the stresses associated with acculturative stress (Potochnick & Perreira, 2010). For example, less acculturated youth tend to be at higher risk for acculturative stressors, language barriers, and disconnected from social resources.

Some youth are at risk of additional stressors related to the acculturation process. Latino youth, for example, often face the challenge of learning a new language and balancing the role expectations and values of the home environment with those of the mainstream culture (Luis et al., 2008). Some research indicates that one specific mechanism of risk refers to acculturation-specific interfamilial difficulties or dissonant acculturation (Rogers-Sirin et al., 2014). Dissonant acculturation are differences in acculturation levels between children and their families, mainly created because children tend to acculturate faster to the host/majority culture, and thus may lead to tension within the family. This parent–child acculturation difference is also referred to as an acculturation gap, and this is when youth acquire greater English-language proficiency, greater exposure to American values, and may disconnect from their culture of origin (Rogers-Sirin et al., 2014). These acculturative gaps are related to higher levels of anxiety and lower self-esteem in ethnic minority youth (Farver, Narang, & Bhadha, 2002).

Acculturation and assimilation

Acculturation and assimilation are processes of transmission of cultural phenomena between minority and majority populations, which reflect immersion of an individual in a culture and the degree of its internalization. Assimilation is the cultural absorption of the minority group by the majority, in which the assimilated group loses its cultural characteristics. Acculturation is transmission of cultural features between groups, in which each of them adopts some of the features of the other group but still remains distinct. Measurement of acculturation to both the majority culture as well as a culture of origin is warranted (Lopez-Class, Gonzalez Castro, & Ramirez, 2011). Acculturation can occur in various degrees along a continuum: from minimal in those who live in ethnic neighborhoods and speak native language, to complete immersion in the majority culture. It involves learning the language, history and traditions of new culture, changing one’s own behaviors, norms, values, worldview, and interaction patterns (Marin, 1992).

Culture dictates attitudes and behaviors during testing, including test-wiseness, proficiency in explicit and implicit requirements for test performance, motivation, feelings of insecurity, perception of possible discrimination, or frustration with time- and effort-consuming evaluation (Perez-Arce, 1999). Individuals from Western cultures usually appreciate that testing is a challenge and that fast and best performances are crucial (Ardila, 2005; Manly, 2006). For Hispanics, it may be more important to establish a relationship with a tester, and Russians tend to value quality of performance more highly than efficiency (Agranovich et al., 2011).

Greater acculturation is generally associated with higher performance on tests of global functioning, executive function, naming, verbal fluency, learning and memory, and processing speed (Arentoft et al., 2012; Coffey, Marmol, Schock, & Adams, 2005; Manly et al., 2004), although results that report lack of differences have also been published (Boone et al., 2007). Personality testing may also be affected by acculturation to the extent that the differences may lead to different diagnoses and management decisions (Cuellar, 2000).

Test-taker’s level of acculturation should be evaluated prior to testing to tailor the evaluation or refer to another specialist who is more proficient in the test-taker’s culture or language. In nonimmigrant groups, acculturation is best assessed by segregation level of schooling and current and/or childhood residential segregation (Manly, 2006). Among immigrant groups, acculturation is best assessed by years in the country, timing of immigration, English language proficiency, bilingualism/most frequently used language at work/home, level, quality, and country of education and employment, and social contacts. Such information may be collected from a test-taker and/or informant (Llorente, 2008; Zebrowski et al., 2015) as well as by formal evaluation of language proficiency and acculturation (Marin & Gamba, 1996; Stephenson, 2005; Unger et al., 2002).

Tests selection should be appropriate for the culture of the test-taker. Depending on the level of acculturation, most appropriate norms should be either derived from immigrant minorities or from those who were born in the country (Llorente, Taussig, Satz, & Perez, 2000). Test results should be interpreted with respect to individual’s test-wiseness, motivation, and other variables related to the level of acculturation. To increase the ecological validity of recommendations, test findings should be placed in social and cultural context of the individual and his/her degree of acculturation (Dana, 1993).

Acculturation

Although acculturation was not tested in immigrant only studies, there was evidence of the importance of this sociocultural factor for insomnia and sleep quality among combined US-born and immigrant Latinx adult samples. In a convenience sample of 60 Mexican-American pregnant women, higher levels of US acculturation was associated with feeling less refreshed upon awakening (D’Anna-Hernandez et al., 2016). Similarly, in a sample of 911 Latinx adults in South Florida, identifying more with US culture, an indicator of acculturation, was associated with increased sleep difficulty (Riley et al., 2008). In one of the first studies to examine the relationship between intergenerational acculturation and sleep in a Latinx sample using parent-offspring matched subsamples from the longitudinal studies Sacramento Area Latino Study on Aging and Niños Lifestyle and Diabetes Study, Martinez-Miller et al. (2019) found that intergenerational US acculturation, operationalized as the match or discrepancy in the level of US acculturation between parents and children across their lifetime, was not significantly associated with prevalence of restless sleep among the adult children (Martinez-Miller et al., 2019).

Acculturation/accumulative stress

Acculturation and accumulative stress, or stress involved in adjusting to a new dominant culture and feeling pressure to adopt the new dominant culture especially regarding the dominant culture’s drinking norms, impacts alcohol use in minority racial/ethnic groups (Park, Anastas, Shibusawa, & Nguyen, 2014). An often-used proxy of acculturation is nativity with those who are born in the U.S. considered to be more acculturated than those born in their country of origin. For both Asian American and Hispanic/Latino adolescents, individuals who are more acculturated are at greater risk for alcohol use, with mediational mechanisms for Hispanic/Latino adolescents being reductions of family closeness and an increased association with substance-using peers (Bacio et al., 2013; Iwamoto et al., 2016). Similarly, Martinez (2006) and Unger, Ritt-Olson, Wagner, Soto, and Baezconde-Garbanati (2009) showed that parent-child acculturation discrepancies, e.g., greater acculturation among adolescents than their parents, are associated with adolescent alcohol use through higher family stress and lower family cohesion. This social context is often coupled with acculturative stress. In a study of different Asian immigrant subgroups, Park et al. (2014) found acculturation and the associated stress to predict alcohol use, though not in adolescents. Alamilla et al. (2019) found acculturative stress and the associated instances of marginalization, alienation, and rejection increased the risk of alcohol use for U.S.-born racial and ethnic minority groups born into immigrant families. In a small study of recently immigrated Hispanic adolescents in late adolescence (14–17 years old), Meca et al. (2019) found bicultural stress, the pressure of adopting a new culture while maintaining your old culture, predicted onset of alcohol use. This suggests acculturation and acculturative stress are racially and ethnically-related risk factors that can increase the risk of alcohol use in minority adolescents.

Acculturation and acculturative stress

Acculturation, as classically defined by Redfield, Linton, and Herskovits (1936), p. 149) is the “phenomena which result when groups of individuals having different cultures come into continuous firsthand contact with subsequent changes in the original culture patterns of either or both groups.” Acculturation describes the complex psychosocial pattern, comprising many aspects of human functioning, of how individuals raised and socialized in one cultural context (their home culture) dynamically attune and adapt to new contexts (Kim & Abreu, 2001). Although acculturation is considered a “neutral” process in that changes may take place in either or both the minority and dominant culture groups, in actuality, acculturation tends to induce more change in one group (the “acculturating group”) than in the other (Berry, 1997). Acculturation on a narrower individual level is referred to as “psychological acculturation” (Graves, 1967). A more recent definition of psychological acculturation is Cuellar and Arnold’s (1995), which specifies the process as change occurring at three levels of individual functioning: behavioral (e.g., language, music, food, and customs), affective (e.g., meanings attached to symbols), and cognitive (e.g., gender role beliefs and fundamental values).

For Arab/MENA Americans, greater acculturation to mainstream American society has been associated with greater life satisfaction (Faragallah, Schumm, & Webb, 1997), better overall health (Tailakh et al., 2016) but differences in acculturation outcomes have emerged based on several factors. Acculturation experiences may differ based on the reasons for immigration, length of stay in the United States, social support, religious identification, and identity factors, just to name a few. In terms of religious identification, Amer and Hovey (2007) found that integration was not associated with better mental health for Muslim Arabs in their sample but both Muslims and Christians reported that integration was their main acculturation strategy. Further, another study found that perceptions of discrimination differed by acculturation level and religious identification. Specifically, Christian Arabs who were highly acculturated reported the least amount of discrimination, whereas Muslim Arabs who were highly acculturated reported the highest level of discrimination (Awad, 2010).

On an individual level, sudden changes in cultural traditions, behaviors, and social skills due to the acculturation process result in acculturative stress. Acculturative stress, as defined by Berry, Kim, Minde, and Mok (1987) is thought to be a direct result of stressors related to the acculturation process that leads to poorer mental health outcomes and psychological distress often taking the form of anxiety and depression. For first-generation immigrants, acculturative stress is a direct, concurrent byproduct of the acculturation process (Trimble, 2003), a resulting “tension of contact” between the minority individual’s ethnic culture and the dominant host culture (Roysircar & Maestas, 2002). Acculturative stress is both the psychological and physical stress of acclimating to a foreign culture in a new country. For voluntary migrants from MENA regions, acculturative stress after resettlement can result from phenomena such as loss of social networks, family separation, language difficulties, loss of employment, loss of social status, “culture shock,” unfamiliarity, discrimination, and feelings of social alienation (Ahmed, Kia-Keating, & Tsai, 2011; Berry, 1997; Rudmin, 2009; Rudmin & Ahmadzadeh, 2001). In addition, for refugees of MENA descent, acculturative stressors may also include limited resources, difficulty meeting basic needs, continual uncertainty, cultural bereavement, separation from loved ones, and exposure to violence (Kia-Keating et al., 2016).

In general, for both voluntary immigrants and refugees of MENA descent, traumatic experiences that occurred in their home country, difficulties experienced during emigration, prejudice, and general negative sentiment in a hostile mainstream American culture after resettlement, may lead to greater acculturation difficulties in the United States for these groups than for other American immigrant groups (Awad et al., 2019). Thus, immigrants and refugees of MENA descent are at a significantly higher risk for stress-related mental health disorders compared to other immigrant groups. For example, in a meta-analysis of MENA immigrants’ resettlement outcomes in the United States, inability to meet basic needs and lack of housing were significantly related to worse mental health outcomes compared to other groups (Porter & Haslam, 2005). For refugees of MENA descent, whose migration trajectory includes not only preflight stressors, but also may include traumatic events and significant adversities experienced during flight and after resettlement in the United States (Kia-Keating et al., 2016), significantly higher levels of acculturative stress is reported, leading to greater risk of trauma-related mental health illnesses such as psychosis, anxiety, and mood disorders (e.g., Bhugra & Becker, 2005).

In both voluntary migrant and refugee populations, acculturative stress predicts clinical depression and psychological distress above and beyond simply perceived stress. It is a stress unique only to those acculturating to a new culture, and statistically and theoretically differs from normal “everyday” stress (Berry, 1997; Hwang & Ting, 2008). In regard to MENA-American immigrants, acculturative stress is a valuable variable in assessing this population’s mental health outcomes. For example, in a study examining the effects of acculturation, ethnic identity, and acculturative stress on the help-seeking attitudes of Assyrian-American immigrants (Roweiheb, 2013), acculturation level was found to be unrelated to help-seeking attitudes, while acculturative stress was a significant predictor. In a sample of Arab adolescents, acculturation stress predicted psychological adjustment and the perceived ability of adolescents to make friends in school, maintain friendships, perform well in school (Goforth, Oka, Leong, & Denis, 2014), and behavior problems (Goforth, Pham, & Oka, 2015).

Level of acculturation has been used in the previous research to identify immigrant or minority groups at higher risk for psychological distress, but level of acculturation in and of itself is a distal variable that does not necessarily directly correlate with increases or decreases in risk (Escobar & Vega, 2000). Acculturative stress may be a more proximal, direct, and therefore accurate variable than degree of acculturation in predicting psychological distress and mental health risk (Hwang & Ting, 2008).

Despite a political focus on immigration from MENA regions over recent years, there has been limited empirical data on the acculturation outcomes, the particular acculturative stressors, and the psychosocial well-being of these immigrants and refugees after resettlement into the United States (Kia-Keating et al., 2016). As displaced persons escaping war and political conflict in their home countries, many MENA refugees undoubtedly experience emigration contexts significantly more traumatic than voluntary migrants in other eras and circumstances. Immigrants and refugees escaping from war and violent political regimes often experience violence and loss of family members in their home countries. During the process of emigrating to asylum countries such as the United States, refugees may also experience traumatic events such as death of loved ones, injury, starvation, and physical and sexual violence. Many MENA-American refugees in the United States may have been traumatically separated from their families and have no realistic prospects of return to their homelands. Immigration for these individuals may be aptly described as a “complete loss of identity and familiarity” (Abbasi, 2015).

In many respects, pre-displacement trauma in the home country and trauma experienced during the migration trajectory imprints deep psychological scars on MENA-American refugees, and members of these communities may need significant mental health intervention for years beyond their initial migration (Marshall, Schell, Elliott, Berthold, & Chun, 2005). Compared to nonrefugee populations, refugees are at a significantly increased risk for chronic psychological disorders and trauma-related mental health disorders, such as depression, post-traumatic stress disorder (PTSD), and somatization (Porter & Haslam, 2005; Ringold, Burke, & Glass, 2005; Wrobel, Farrag, & Hymes, 2009). Numerous studies have linked exposure to violence to physical and mental health difficulties among refugees of MENA descent (Kia-Keating et al., 2016). Researchers have noted elevated levels of psychiatric illness among refugees as compared to voluntary migrants also from MENA regions. In one comparison study of an Iraqi refugee and an Arab nonrefugee sample at a mental health clinical site, Jamil et al. (2002) found that Iraqi refugees reported a greater likelihood of PTSD and health problems when compared to the nonrefugee Arab-American individuals. A similar survey found that approximately 50% of surveyed Iraqi refugees reported prevalence of emotional distress, anxiety, and depression and 31% were at high risk for post-traumatic stress disorder (Taylor et al., 2014). In general, many MENA-American immigrants report significant levels of psychological distress, which may be linked to their past immigration experiences and present acculturation difficulties. For example, one longitudinal study found that preimmigration trauma was associated with higher levels of PTSD and depression and predicted acculturation struggles a year later (LeMaster et al., 2018).

Abstract

Acculturation influences parenting behaviors, the ways cultural values are expressed, the adaptations parents make in response to their host culture environments, and the ways in which they transmit their heritage culture while socializing their children to function in the host culture. Varying levels of acculturation among family members in immigrant families can result in an acculturation gap between parents and children that influences children’s mental health outcomes in both positive and negative ways. Linguistic acculturation differences between immigrant parents and children can also result in adolescents functioning as translators (language brokers) for their English-limited parents, with subjective appraisals of the language-brokering experience providing more consistent evidence for its effects on adolescent outcomes. We present evidence for the conditions under which parenting behaviors, acculturation gap, and language brokering may represent sources of risk or protection for adolescent mental health in Latinx and Asian immigrant families by using examples from research on Chinese and Mexican immigrant families.

Acculturation measuring tools

Given that acculturation science has existed for decades, it is no surprise that there are currently at least 26 measures used to assess acculturation (Wallace, Pomery, Latimer, Martinez, & Salovey, 2010). In general, acculturation scales assess the effect of acculturation perceptions of nationality, kinship, cultural processes, and perceived health beliefs (Oetzel, De Vargas, Ginossar, & Sanchez, 2007; Pérez-Escamilla & Putnik, 2007). Most scales evaluate individual’s social and cultural knowledge, behaviors, and attitudes on responses to the length of time in the United States, place of birth, language and media preferences, social network composition, and subjective questions of acculturation, with the aim of quantifying an individual’s degree of acculturation. These questions are typically used to evaluate the acculturation process across multiple immigrant groups, genders, and ages and lack often specificity. Acculturations scales range from 4 to 62 items and can be administered through multiple modes and in different languages. It is also the case that acculturation scales can be unidimensional or bidimensional. A unidimensional scale measures the process of acculturation on a linear continuum that ranges from total immersion in one’s heritage culture to the host’s culture (Lara, Gamboa, Kahramanian, Morales, & Hayes Bautista, 2005). In contrast, bidimensional scales typically measure (a) acculturation, the extent to which an individual adopts the host culture, and (b) enculturation, the extent to which they retain their heritage culture (Padilla, 1980).

In theory, the existing acculturation scales should do a fine job of capturing the theory of acculturation. However, this is not the case. Evidence shows that acculturation measures often do not agree, even among similar samples and similar outcomes. This is problematic to the field as it leads to mixed findings and inconsistent science. Though research is limited, evidence across the two metaanalyses shows that acculturation measures were strikingly inconsistent (Table 1; Alvarez et al., 2017, 2018). It is important to note that the two analyses used similar inclusion criteria. Such that (a) only studies with immigrant Latinx populations were used and (b) scientists must have measured acculturation either through a formal scale or with a language proxy.

Table 1. Correlations between acculturation and health behaviors by measure.

Across both metaanalytic reviews, the most common scales were the language proxy scales, the Caetano scale, and the ARSMA scale (Alvarez et al., 2017, 2018). Across and within both health domains, the scales produced notably different patterns of results. For example, while the ARSMA had a correlation of 0.19 with alcohol use, the measure failed to predict intimate partner violence (r = −  0.003). This is consistent with the pattern of associations shown in Table 1—some acculturation measures that predicted alcohol use, did not predict IPV among Latinxs and the strength of the association varied considerably within each health domain (Alvarez et al., 2017, 2018). The acculturation and alcohol use metaanalyses revealed that the strongest correlation was produced by studies that used the language proxy. The language proxy is a crude indicator of the extent to which an individual acculturates as it uses the language in which the survey was completed to designate a level of acculturation. Clearly, this is problematic because it is a limited and one-dimensional metric of the mechanism or the degree to which an individual has adopted the host culture and retained their heritage culture. Furthermore, the Cuellar (1980) scale produced the weakest correlation, which was not statistically significant. The findings in the alcohol use review produce serious questions regarding inconsistency but are heightened by the fact that the language proxies yielded a stronger and significant relationship. The acculturation and intimate partner violence review produced different findings. In this review, the Caetano (1987) scale produced the strongest relationship and the language proxy produced the weakest. The difference between these two correlations is large enough to warrant concern, given that these two measures are supposed to measure the same underlying concept and test an effect across similar samples and behaviors.

The highly inconsistent results across the two domains suggest that any particular measure of acculturation might be a poor predictor for a range of behaviors. This is consistent with the specificity hypothesis presented earlier. Thus, we question if the measures are flawed, if the theories are flawed, or if it is simply unreasonable to expect broad measures of behavior (e.g., television watching preferences, social network choices) to predict specific forms of behavior. Furthermore, it is a call to think critically about acculturation measures and what they should predict. It may very well be the case that acculturation measures need to be domain specific, and researchers will need to analyze for important moderators to any particular effect. It may also be the case that researchers need to look beyond media consumption, for instance, and identify psychological variables that might predict the ability to adapt to new environments as the central goal of new acculturation measures.

Many of these scales have remained unchanged for decades (Wallace et al., 2010). Particularly, one can argue that the State’s attitudes and behaviors toward immigrants in the 1980s and 1990s notably differed from the time this chapter was written, in 2019. Acculturation is more than one person simply adapting to a new environment. It is also how well that environment is accepting of the person attempting to acculturate. In fact, some measures of acculturation specifically include social network items in their scales. Yet, acculturation measures have not been modified or updated to account for societal turmoil that aggressively targets immigrants and, therefore, their adaptation process. While it is the case that assessing language of media consumption and social network composition are insightful given the current political context, current acculturation measures lack an evaluation of the impact negative social rhetoric can have on domain-specific acculturation. Assessing the interaction between context and acculturation can have important clinical and practical implications.

Expanding the Acculturation Framework

Acculturation and adaptation occur in multilayered contexts, textured not just by prejudice and discrimination, but also majority expectations and perceptions about the cultural maintenance preferences of migrants themselves (e.g., Bourhis et al., 1997; Brown & Zagefka, 2011; Piontkowski, Rohmann, & Florack, 2002; Tip, Zagefka, González, Brown, Cinnirella, & Na, 2012; Van Oudenhoven, Prins, & Buunk, 1998; Zagefka & Brown, 2002). Thus, for example, whereas minority members’ inclinations to integrate can be encouraged by their perception that this is also supported by the majority (Zagefka, Brown, & González, 2009), in some contexts there is a prevailing misperception that immigrants prioritize separation rather than integration (e.g., Van Oudenhoven et al., 1998; Zagefka & Brown, 2002). Indeed, in the summer of 2016, majorities in most European countries felt that Muslims want to be distinct from the larger society instead of adopting the “customs and way of life” of the mainstream (Pew Research Centre, 2016).

The interactive acculturation model (Bourhis et al., 1997) specifies how the congruence or mismatch between acculturation orientations of migrants and those of the receiving society can promote or undermine intergroup harmony. There is a corresponding wealth of evidence that preferences for different cultural maintenance strategies are correlated with other intergroup variables, such as desire for contact, ingroup bias, and discrimination (see Brown & Zagefka, 2011, for a review). The model also recognizes the role of public policy in framing the normative context of cultural adoption preferences. Indeed, these preferences can be conceptually reframed in terms of intergroup ideologies (see Guimond et al., 2014), including multiculturalism, which in turn predict intergroup attitudes. In one compelling example of these links in the context of anti-Muslim prejudice, Guimond et al. (2013) demonstrated that: (1) attitudes toward Muslims were more positive in countries with stronger prodiversity policies (e.g., Canada compared to Germany); (2) across countries, diversity policies corresponded systematically with perceived norms reflecting assimilation and multiculturalism; and (3) the personal endorsement of those norms were in turn predictive of prejudice, particularly when the norms were salient.

Nations have unique historical and contemporary experiences with immigration, and evolving institutional features that reflect those experiences, as well as responses to new demands. To a large extent, social policy determines the sorts of outcomes, including citizenship, that are possible for migrants. Exclusion can assume a number of institutional forms, including poor prospects for long-term employment, social security, and permanent residency, the denial of basic political liberties, structural barriers to family reunification, inaccessibility to education and health care, and inadequate access to language training (Migrant Integration Policy Index, 2015). Together, these provide substantial and potentially insurmountable barriers to integration for some newcomers. Of course, migrants can be, and are, excluded outright based on policies regarding immigration, admissibility of asylum seekers, and refugee resettlement.

Based on various social policies (e.g., related to migrants’ labor market mobility, education, health, family reunion, access to citizenship, and protection from discrimination) historically immigration-based countries (e.g., Australia, Canada, New Zealand) tend to be more institutionally conducive to the integration of migrants than European Union countries (as ranked by the Migrant Integration Policy Index, 2015). In turn, Northern and Western European countries with established minority populations rank more highly then those in Southern and Eastern Europe, where experience with immigration and migrants is more recent. These differences roughly correspond to patterns of public opinion in the context of contemporary debates about migration (European Social Survey, 2016). For example, the Pew Research Center (2016, July) found that majorities in Hungary (72%), Italy (69%), Poland (66%), and Greece (65%) expressed negative attitudes toward Muslims, compared to the Netherlands (35%), Sweden (35%), France (29%), Germany (29%), and the United Kingdom (28%).

In summary, majority attitudes and expectations act reciprocally with social policy to reflect and reinforce an ideological climate that may be more or less accepting of migrants. This climate is also closely tied to the promotion of particular meanings of national identity, which have direct implications for whether (and which) migrants are able to enter, and to aspire to rights, residency, or citizenship.

Globalization and Emotional Experience

Acculturation research suggests that globalization and its mediums may homogenize emotional experience across cultural divides. We know from previous research that people who interact with each other on a daily basis tend to become more emotionally similar over time (e.g., Anderson, Keltner, & John, 2003; Totterdell, 2000) because “people’s emotions become attuned to their enduring social relationships” (De Leersnyder, Mesquita, & Kim, 2011, p. 451). This conclusion was based on de Leersnyder et al.’s (2011) study of immigrants, whose emotional concordance with natives of their host society increased both with the time spent in this new culture, and the extent of their social relationships with host natives. To our knowledge, there is no research explicitly focusing on globalization processes and emotional concordance, but it is plausible that transnational cooperation and social contact can have a similar effect on emotional acculturation. It is thus likely that, as people from different cultures interact positively through social media, they build up a common rapport, which may include shared forms of emotionality (cf. Roempke et al., 2018). Furthermore, because these transnational social contacts are often carried out in a distinctly globalized setting (e.g., on SNS, in fan communities of international consumer brands and icons, called fandoms), they are suffused with Western-globalized culture’s values and accompanying emotional norms. Research has shown that those who participate in more globalized fandoms tend to embrace globalized culture’s values (i.e., valuing diversity), and exhibit globalized collective emotions, such as empathy for outgroup members (Plante, Roberts, Reysen, & Gerbasi, 2014).

The emergence of globalized collective emotions is both a consequence and antecedent of awareness of and emotional connectedness with others, no matter how geographically remote (Reysen & Katzarska-Miller, 2013). As such, globalized collective emotions are intimately linked both to forms of globalized identities, and global collective action; two topics we will revisit in Chapter 6. These globalized collective emotions are not necessarily mediated by direct interpersonal contact, however. Often, they are disseminated by mass media, which inform viewers around the world about ongoing events, and how these events should be received, emotionally. In an early example of this, many have written about the importance of 1985’s “Live Aid” concerts addressing African famine, to the development of shared global emotions, and the incipient global community, more generally (e.g., Urry, 1999). Others, however, argue that similar highly marketed events such as “Live 8”—a set of benefit and charity concerts that took place in the G8 states in 2005—use such emotional narratives to produce “global citizens” that follow and shape the neoliberal facets of globalization (Biccum, 2007).

Hence, globalized emotions are also shaped by the less interpersonal acculturative processes tied with shared exposure to the global media and structures of consumer culture. Global mass media, with its formats of news, fiction, and commercials, is a powerful source of emotional acculturation. As mentioned above, global news coverage informs viewers how to feel about local and global events (e.g., by the tone of commentary or the carefully orchestrated change in anchors’ facial expression). Fiction likewise models appropriate emotional reactions, both directly (by the protagonists) and by setting the cinematic scene to evoke the desired viewer response. Commercials, in particular, target viewers’ emotions (Bagozzi, Gopinath, & Nyer, 1999), and cumulatively instill emotional norms (Illouz, 2007). We all know how delighted we should feel if we are fortunate enough to buy the “right” car, eat at the “right” restaurant, or go on a “dream” cruise (see also Chapter 3).

Indeed, as marketing science demonstrates, some emotions sell better than others: we usually look for something new to excite us and titillate our senses (Holbrook & Hirschmann, 1982). In a Western cultural framework, that seems almost self-evident. However, psychological research has shown that different cultures idealize different emotional states that prescribe what members should seek in their daily lives. For example, while Americans tend to rank states high on arousal and positivity (e.g., excitement) as optimal, in East Asian cultures, the preference is for lower arousal positive emotions (e.g., calm; Tsai, 2007). Because hedonism is so central in contemporary consumerism (see Chapter 3), preference for this Western type of emotional experience may be increasing around the world as consumer culture globalizes. Here again we see how consumerist forms, ostensibly separate from the more explicitly value-laden influences of globalized Western culture, may slowly affect cultural changes around the world.

So, while some scholars point to globalization eliciting both positive (through exchange of ideas, goods, and practices) and negative (through uncertainty or loss of local cultures) emotions (e.g., Hermans & Dimaggio, 2007), there is little empirical research investigating the (collective) emotional reactions that are elicited by globalization-related information. Clearly, it depends on how globalization is framed: When globalization is depicted as a process that makes the job market more competitive, students reported fewer positive emotions, lower global identification, and increased desire to reject outgroups, compared to a depiction of globalization as a process that fostered a culturally diverse world (Snider, Reysen, & Katzarska-Miller, 2013). Yet, for the time being, we know little more about the effects of globalization on emotional responses.